The impact of atrial fibrillation on accuracy of oscillometric blood pressure measurement: effect of ventricular rate
Abstract
This study evaluated the impact of ventricular rate (VR) in atrial fibrillation (AF) patients with oscillometric BP measurements. This study included 138 patients with AF and 112 patients with sinus rhythm (SR) who underwent coronary angiography. Left arm BP was measured three times with an oscillometric device, and the average was recorded as the final oscillometric value. At the same time, the average of three intra-aortic BP readings was used as invasive values. Delta BP was the difference between intra-aortic and oscillometric BP. Meanwhile, the BP percentage difference (PD-BP) was calculated with the following formula: PD-BP = (delta BP/intra-aortic BP) × 100%. Based on the VR, four subgroups of AF and SR patients, <80, 80-99, 100-120, and >120 bpm, were created, and the mean PD-BP for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) was significantly higher in the AF group than in the SR group. Moreover, the mean PD-SBP values gradually increased as VR increased in both groups. More importantly, the difference in PD-SBP between the AF and SR groups increased as VR increased: when VR was <80 bpm, the levels were similar (-2.0 ± 3.5 vs. -1.4 ± 2.7 mm Hg, NS), but these values in AF patients were significantly higher when VR was 80-99 bpm (-3.7 ± 5.0 vs. -1.8 ± 2.3 mm Hg, p < 0.05), 100-120 bpm (-6.1 ± 4.3 vs. -2.3 ± 1.9 mm Hg, p < 0.05) and >120 bpm (-7.8 ± 4.9 vs. -2.9 ± 1.7 mm Hg, p < 0.05). The accuracy of oscillometric BP measurements are dependent on the ventricular rate in AF patients even after three measurements, and a higher ventricular rate may result in larger underestimations of oscillometric BP.
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Current evidence from published validation studies of automated oscillometric BP monitors in atrial fibrillation is limited and methodologically heterogeneous.
“The current evidence from published validation studies of automated oscillometric BP monitors in atrial fibrillation is rather limited and methodologically heterogeneous [15,212,215].”
Screening for atrial fibrillation in the elderly using an atrial fibrillation-specific algorithm during routine automated office, home or ambulatory BP measurement has high diagnostic accuracy.
“Accumulating evidence suggests that screening for atrial fibrillation in the elderly using an atrial fibrillation-specific algorithm during routine automated office, home or ambulatory BP measurement has high diagnostic accuracy [212,218,219].”
In the presence of atrial fibrillation, both manual auscultatory and automated oscillometric measurement of BP are difficult and uncertain because of variations in ventricular filling time, stroke volume and contractility, which increase beat-to-beat BPV.
“In the presence of atrial fibrillation, both the manual auscultatory and the automated oscillometric measurement of BP are difficult and uncertain because of variations in ventricular filling time, stroke volume and contractility, all of which increase beat-to-beat BPV [212].”
Automated oscillometric devices have reasonable accuracy in measuring SBP in atrial fibrillation but with a small yet consistent overestimation of DBP (pooled automated minus auscultatory SBP difference 1 mmHg, 95% CI −0.1 to 2.1, and DBP 2.1 mmHg, 95% CI 0.1-4.0).
“it appears that there is reasonable accuracy of these devices in measuring SBP in the presence of atrial fibrillation but with a small yet consistent overestimation of DBP (pooled automated minus auscultatory SBP difference 1 mmHg, 95% CI −0.1 to 2.1, and DBP 2.1 mmHg, 95% CI 0.1--4.0) [212].”
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- Authors
- Xie, F., Xu, J., Xia, L.-L., Luo, X., Jiang, Z., Wu, Y., & Su, H.
- Affiliations
- Second Affiliated Hospital of Nanchang University (CN)
- Nanchang University (CN)
- Corresponding author
- Su, Hai
- Venue
- Hypertension Research
- Published
- 2020-01-10
- Volume
- 43
- Issue
- 6
- Pages
- 518-524
- ISSN
- 0916-9636 (ISSN-L)
- 1348-4214
- OpenAlex
- W3000050477
- Cited by
- 21
- References
- 27
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 4
- FWCI
- 2.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- atrial fibrillation, oscillometric blood pressure measurement, ventricular rate, blood pressure measurement accuracy, systolic blood pressure, diastolic blood pressure, sinus rhythm, coronary angiography
- MeSH terms
- Aged, Aged, 80 and over, Atrial Fibrillation, Blood Pressure, Blood Pressure Determination, Cross-Sectional Studies, Female, Heart Rate, Heart Ventricles, Humans, Male, Middle Aged, Oscillometry
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